title: Nonoperative management of major blunt liver injury with hemoperitoneum.
abstract: We evaluated the role of nonoperative therapy in 16 patients with blunt multisystem trauma, hemodynamic stability following resuscitation, and major lobar liver injury; the patients were treated with a protocol of intensive care unit observation and computed tomographic scanning to identify and follow up the hepatic lesion. Computed tomographic scans showed right-lobe or bilobar liver lacerations and/or subcapsular hematomas in all patients and associated hemoperitoneum in 8 patients. Exploration was required in 2 patients; both were found to have a hemoperitoneum and a nonbleeding liver laceration. There were no deaths. Patients with hemoperitoneum requiring transfusion had significantly greater injury severity scores and longer intensive care unit and hospital stays. The major advantage of a nonoperative approach is the opportunity to stabilize major extra-abdominal (particularly head) injuries as the first priority. Unstable hemodynamics, abdominal distension, and falling hematocrit are indications for prompt exploration. Nonoperative care of these injuries requires a strict treatment protocol.
authors.affiliation: Trauma and Emergency Surgery Service, UCLA Medical Center 90024.
authors.forename: J R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: H D
authors.initials: HD
authors.lastname: Harrier
authors.forename: B V
authors.initials: BV
authors.lastname: Koenig
authors.forename: K J
authors.initials: KJ
authors.lastname: Ransom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D003288:Contusions / Q000000981:diagnostic imaging; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*